We are continously striving to update our approach to create the most functional and virutal vaginoplasty vulvas possible. Posted this past month are photographs 3/1-2 and 8/1-4 http://srsmiami.com/photography-m2f.html
The incidence of touch ups, all practices, may be as high as 35% and we offer this to our one stage feminizing vaginoplasty patients gratis after 3 months.
Harold M. Reed, M.D.
This is the desired new standard for MTF surgery and something we strive to do with our patients such as examples 3/1-2 and 8/1-5 in our photo gallery http://srsmiami.com/photography-m2f.html
Lubricious could mean:
1. Having a slippery or smooth quality.
2. Shifty or tricky.
3.
a. Lewd; wanton.
b. Sexually stimulating; salacious
However, before I knew of meanings 2 and 3, this was a familiar
urological term that describes a catheter with a hydrophilic suface
(loves water literally) that glides in a lot more easily than standard
catheters and is better tolerated by patients. They are more costly,
but for years we have only used lubricious catheters in MTF surgery
at our center.
This term has been re-coined by me to describe a technique that I
learned from Dr. Marci Bowers, using urethral mucosa for constructing
the vulvar plate. There is somewhat more lubrication there, but also
the color of the tissue is pinker and seems to resemble natal vulvas
a lot better than typical pigmented epithelium. The inner aspect of
the labia minora on natal woman are pink, whereas the outer aspect is
darkly pigmented. The vulvar plate is confluent with the inner
aspect of the labia minora. Marci uses a 2 layered suture to raise
the edge and quite frankly, I was inspired by her technique.
Harold Reed, M.D.
Our office receives periodic inquiries from patients often outside our
practice as what might be the cause and how best to treat.
The differential diagnosis includes, a suture remnant which might be
infected, but usually this will reabsorb after a while. I do not know
of any surgeons using non-absorbable sutures for vaginoplasty. Also a
space that has not closed in, a drainage tract. But in this case we
have to think of the nidus (or cause) and treat that. The drainage
tract is only the natural consequence of fluid (usually infected)
build up seeking to drain. Occasionally there may be a recto-vesical
fistula or a communication between bowel or bladder and the vagina.
This may close spontaneously, but if not, should be addressed for the
sake of patient comfort, as well as bringing the operation to a functional
conclusion, and to prevent possible worsening of an abscess and/or tissue
necrosis.
Drainage may be a sign of tissue necrosis, such as a devitalized
clitoris or neurovascular bundle or penile remnants attached to that
bundle. Distal nerves may regenerate, but the tract must be widely
opened first and any necrotic components must be debrided.
Smokers and diabetics and those with hyperlipidemia (elevated fats and
cholesterol), and older age patients are more prone to this unusual
situation. Inappropriate stent usage, trauma, and early sexual
activity also could be a factor.
Previous pelvic surgery can devitalize blood supply, so we cannot be
fooled by what may look normal, as skin that has been exposed to lots
of sunshine during adolescent may not bear signs of actinic effects
till years later on.
Lastly, we have noted one of the most common causes of continued pain, drainage
and irritation, is the retention of an epithelial surface under the vulvar
plate. In that the clitoris is formed from the glans penis, one has to be
assiduous about removing skin that is not intended to be exposed or hooded.
Skin exudes debris and sebum at times. Skin under skin will not heal and forms
epithelial cysts, all kinds of chronic reactions, and granulomas. Buried skin
may want to encyst. All this is highly inflammatory. The answer is to open the
area. Cauterize or apply in lesser instances a silver nitrate stick.
Harold M. Reed, M.D.
Dear SueEllen,
Yes, quite agree. Scrotal grafting is the key to depth. Please see our photographic examples, panels 6/1-5 for scrotal graft preparation and on lay.
Hope this is of help,
Harold M. Reed, M.D.
Re: Depth (from http://groups.yahoo.com/group/MTF-SRS-FTM/message/40720)
The discussion started out by a patient saying her doctor was not able to make a depth of over 4 1/2 inches and blamed it on her perineum which is short.
Reply from another…
The perineal flap is not that long regardless and does not play into depth but very important to provide a proper entree into the vaginal introitus or opening and of course provides girth at the opening or outer portion of the vagina. Girth not depth. It is sewn into the back wall of the vagina to funnelize the vagina. For depth, the scrotal graft with rare exception is unsurpassed as this skin when properly thinned stretches quite easily.
SueEllen, RN
Hi there was searching Google for vaginal hair and your blog regarding Vaginal stenosis after feminizing vaginoplasty looks really interesting for me. I will definitely bookmark it and come back for more cool postings to read!
Cheers!
Beth, hope you know, EMLA has to be left on the skin for 20 minutes.
For electrolysis down below, we inject with xylocaine, but ours is a doctor’s
office and most technicians are not able to do that medically-legally.
Harold Reed, M.D.
Jun 9, 1:40 PM — [ Edit | Delete | Unapprove | Approve | Spam ] — Vaginal stenosis after feminizing vaginoplasty
Sep 18, 12:25 PM — [ Edit | Delete | Unapprove | Approve | Spam ] — Thanks to all, many our own post-ops. who have talked about the Grant
Brings vintage wine and leaves with revision of work done in another part of the world. The critique includes asymmetrical labia minora, no clitoral body and no clitoral sulci, sagging left labia majora, anterior commissure off to the right, labia majora without typical fatty prominence, V-spreading of the anterior commissure. Plenty to do. The labia majora were enhanced with autologous fat transfer from the lower abdomen.. The entire procedure was done under epidural and lasted about 2 1/2 hours.
Harold M. Reed, M.D.